Thomas Rohit Philip, Kowald Tobias, Schmuck Bernhard, Eldergash Osama, Klausen Andreas, Dikov Valentin, Easo Jerry, Chavan Ajay
Institute for Diagnostic and Interventional Radiology, Klinikum Oldenburg AöR, Oldenburg, Germany.
Department of Anaesthesia, Intensive care medicine, Emergency medicine and Pain therapy, University Hospital, Klinikum Oldenburg AöR, Oldenburg, Germany.
Rofo. 2017 Apr;189(4):347-355. doi: 10.1055/s-0043-101387. Epub 2017 Mar 23.
To evaluate the safety of percutaneous endovascular aortic repair and the relationship of access site characteristics to complications All patients undergoing percutaneous TEVAR, EVAR and FEVAR procedures from January 2010 to May 2016 were retrospectively analysed for incidence of complications and their relationship to various access site characteristics like access artery size, degree of vessel calcification, skin to artery distance and sheath to artery ratio. Hemostasis occurring within 15 min after suture closure with or without manual compression was defined as primary hemostasis. 92 patients with 142 femoral access sites were included in the study. Median follow-up was 28.13 months (range 2.5 - 76.7 months, Mean 32.39, SD - 21.66 months). Introducer system size ranged from 12F to 25F. Primary haemostasis was achieved in 97.1 % (138/142) of the total femoral access sites. Four access sites (2.8 %) had to be closed surgically; in all 4 cases the introducer systems was ≥ 18F. Two of these access sites had been operated upon previously. Late complications including inguinal hematoma (n = 7), wound infection (n = 1), scrotal hematoma (n = 1), pseudoaneurysm (n = 4) and late bleeding (n = 4) occurred in 17 access sites (11.9 %), of which 13 were managed conservatively. On account of the low complication rate, no correlation between the evaluated variables and observed complications could be established. Percutaneous endovascular aortic repair is feasible and safe irrespective of the size of the introducer sheath and the nature of aorto-iliac pathology. The technical success rate is high and the incidence of complications is low. Early complications are most often associated with sheath sizes ≥ 18 F. The majority of the late complications can be treated conservatively. · Percutaneous endovascular aortic repair is feasible and safe.. · Technical success rate is high and complication rate is low.. · Vascular closure device failure in the occasional patient may necessitate surgical intervention.. · Thomas RP, Kowald T, Schmuck B et al. Retrospective Evaluation of Percutaneous Access for TEVAR and EVAR: Time to Make it the Standard Approach?. Fortschr Röntgenstr 2017; 189: 347 - 355.
评估经皮血管腔内主动脉修复术的安全性以及穿刺部位特征与并发症的关系 对2010年1月至2016年5月期间接受经皮胸主动脉腔内修复术（TEVAR）、腹主动脉腔内修复术（EVAR）和烟囱技术辅助腔内修复术（FEVAR）的所有患者进行回顾性分析，以研究并发症的发生率及其与各种穿刺部位特征的关系，如穿刺动脉大小、血管钙化程度、皮肤至动脉距离以及鞘管与动脉比例。缝合关闭后15分钟内（无论是否手动压迫）实现的止血被定义为一期止血。 本研究纳入了92例患者的142个股动脉穿刺部位。中位随访时间为28.13个月（范围2.5 - 76.7个月，平均32.39，标准差 - 21.66个月）。导入系统尺寸范围为12F至25F。在全部股动脉穿刺部位中，97.1%（138/142）实现了一期止血。4个穿刺部位（2.8%）需要手术关闭；在所有4例中，导入系统≥18F。其中2个穿刺部位此前已接受过手术。17个穿刺部位（11.9%）出现了晚期并发症，包括腹股沟血肿（n = 7）、伤口感染（n = 1）、阴囊血肿（n = 1）、假性动脉瘤（n = 4）和晚期出血（n = 4），其中13例采用保守治疗。由于并发症发生率较低，无法确定所评估变量与观察到的并发症之间的相关性。 无论导入鞘管的大小以及主动脉 - 髂动脉病变的性质如何，经皮血管腔内主动脉修复术都是可行且安全的。技术成功率高，并发症发生率低。早期并发症最常与鞘管尺寸≥18F相关。大多数晚期并发症可以保守治疗。 · 经皮血管腔内主动脉修复术是可行且安全的。· 技术成功率高，并发症发生率低。· 偶尔有患者血管闭合装置失败可能需要手术干预。· 托马斯·R·P、科瓦尔德·T、施穆克·B等。TEVAR和EVAR经皮穿刺的回顾性评估：是时候将其作为标准方法了吗？。《德国放射学杂志》2017年；189: 347 - 355。
